During an abdominoperineal resection, injury to the hypogastric nerve plexus is a recognised complication. Which functional deficits would result from injury to the inferior hypogastric (pelvic) plexus?

• A Fecal incontinence due to internal anal sphincter paralysis only
• B Loss of testicular sensation only
• C Bladder dysfunction (atonic bladder) and erectile dysfunction (loss of parasympathetic erection) ✓
• D Isolated loss of ejaculation

Explanation

The inferior hypogastric plexus (pelvic plexus) contains both sympathetic (from the hypogastric nerve, T10–L2) and parasympathetic (pelvic splanchnic nerves, S2–S4) fibres. Together they control: bladder contraction (parasympathetic, detrusor); internal urethral sphincter tone (sympathetic maintains closure); penile erection (parasympathetic via cavernous nerves — 'nervus erigentes'); and ejaculation (sympathetic). Injury causes atonic/neurogenic bladder, sexual dysfunction (inability to achieve erection and/or ejaculation), and can affect defecation. Identifying the hypogastric nerve plexus during lateral pelvic dissection is a critical step in nerve-sparing rectal cancer surgery.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.